An Approach to Interpreting Spirometry



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Spirometry is a powerful tool that can be used to detect, follow, and manage patients with lung disorders. Technology advancements have made spirometry much more reliable and relatively simple to incorporate into a routine office visit. However, interpreting spirometry results can be challenging because the quality of the test is largely dependent on patient effort and cooperation, and the interpreter's knowledge of appropriate reference values. A simplified and stepwise method is key to interpreting spirometry. The first step is determining the validity of the test. Next, the determination of an obstructive or restrictive ventilatory patten is made. If a ventilatory pattern is identified, its severity is graded. In some patients, additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing are needed. These tests can further define lung processes but require more sophisticated equipment and expertise available only in a pulmonary function laboratory.

Chronic obstructive pulmonary disease (COPD) is the most common respiratory disease and the fourth leading cause of death in the United States.1 Despite preventive efforts, the number of new patients with COPD has doubled in the past decade, and this trend is likely to continue.2,3 Evidence indicates that a patient's history and physical examination are inadequate for diagnosing mild and moderate obstructive ventilatory impairments.4 Although a complete pulmonary function test provides the most accurate objective assessment of lung impairment, spirometry is the preferred test for the diagnosis of COPD because it can obtain adequate information in a cost-effective manner.

A great deal of information can be obtained from a spirometry test; however, the results must be correlated carefully with clinical and roentgenographic data for optimal clinical application. This article reviews the indications for use of spirometry, provides a stepwise approach to its interpretation, and indicates when additional tests are warranted.

Background

The National Health Survey of 1988 to 1994 found high rates of undiagnosed and untreated COPD in current and former smokers.5 Population-based studies have identified vital capacity (VC) as a powerful prognostic indicator in patients with COPD. The Framingham study identified a low forced vital capacity (FVC) as a risk factor for premature death.6 The Third National Health and Nutritional Examination Survey and the multicenter Lung Health Study showed potential benefits for patients with early identification, intervention, and treatment of COPD.7,8 The Lung Health Study was the first study to show that early identification and intervention in smokers could affect the natural history of COPD.7 These surveys also showed that simple spirometry could detect mild airflow obstruction, even in asymptomatic patients.

Increased public awareness of COPD led to the formation of the National Lung Health Education Program (NLHEP) as part of a national strategy to combat chronic lung disease.9 The World Health Organization and the U.S. National Heart, Lung, and Blood Institute recently published the Global Initiative for Chronic Obstructive Lung Disease to increase awareness of the global burden of COPD and to provide comprehensive treatment guidelines aimed at decreasing COPD-related morbidity and mortality.10

TABLE 1

Glossary

Spirometric values

FVC—Forced vital capacity; the total volume of air that can be exhaled during a maximal forced expiration effort.

FEV1—Forced expiratory volume in one second; the volume of air exhaled in the first second under force after a maximal inhalation.

FEV1/ FVC ratio—The percentage of the FVC expired in one second.

FEV6 —Forced expiratory volume in six seconds.

FEF25–75%—Forced expiratory flow over the middle one half of the FVC; the average flow from the point at which 25 percent of the FVC has been exhaled to the point at which 75 percent of the FVC has been exhaled.

MVV—Maximal voluntary ventilation.

Lung volumes

ERV—Expiratory reserve volume; the maximal volume of air exhaled from end-expiration.

IRV—Inspiratory reserve volume; the maximal volume of air inhaled from end-inspiration.

RV—Residual volume; the volume of air remaining in the lungs after a maximal exhalation.

VT —Tidal volume; the volume of air inhaled or exhaled during each respiratory cycle.

Lung capacities

FRC—Functional residual capacity; the volume of air in the lungs at resting end-expiration.

IC—Inspiratory capacity; the maximal volume of air that can be inhaled from the resting expiratory level.

TLC—Total lung capacity; the volume of air in the lungs at maximal inflation.

VC—Vital capacity; the largest volume measured on complete exhalation after full inspiration.

TABLE 1   Glossary

View Table

TABLE 1

Glossary

Spirometric values

FVC—Forced vital capacity; the total volume of air that can be exhaled during a maximal forced expiration effort.

FEV1—Forced expiratory volume in one second; the volume of air exhaled in the first second under force after a maximal inhalation.

FEV1/ FVC ratio—The percentage of the FVC expired in one second.

FEV6 —Forced expiratory volume in six seconds.

FEF25–75%—Forced expiratory flow over the middle one half of the FVC; the average flow from the point at which 25 percent of the FVC has been exhaled to the point at which 75 percent of the FVC has been exhaled.

MVV—Maximal voluntary ventilation.

Lung volumes

ERV—Expiratory reserve volume; the maximal volume of air exhaled from end-expiration.

IRV—Inspiratory reserve volume; the maximal volume of air inhaled from end-inspiration.

RV—Residual volume; the volume of air remaining in the lungs after a maximal exhalation.

VT —Tidal volume; the volume of air inhaled or exhaled during each respiratory cycle.

Lung capacities

FRC—Functional residual capacity; the volume of air in the lungs at resting end-expiration.

IC—Inspiratory capacity; the maximal volume of air that can be inhaled from the resting expiratory level.

TLC—Total lung capacity; the volume of air in the lungs at maximal inflation.

VC—Vital capacity; the largest volume measured on complete exhalation after full inspiration.

Spirometry Measurements and Terminology

Spirometry measures the rate at which the lung changes volume during forced breathing maneuvers. Spirometry begins with a full inhalation, followed by a forced expiration that rapidly empties the lungs. Expiration is continued for as long as possible or until a plateau in exhaled volume is reached. These efforts are recorded and graphed. (A glossary of terms used in this article can be found in Table 1.)

Lung function is physiologically divided into four volumes: expiratory reserve volume, inspiratory reserve volume, residual volume, and tidal volume. Together, the four lung volumes equal the total lung capacity (TLC). Lung volumes and their combinations measure various lung capacities such as functional residual capacity (FRC), inspiratory capacity, and VC. Figure 111 shows the different volumes and capacities of the lung.

Lung Volumes and Capacities

FIGURE 1.

Lung volumes and capacities.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:783.

View Large

Lung Volumes and Capacities


FIGURE 1.

Lung volumes and capacities.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:783.

Lung Volumes and Capacities


FIGURE 1.

Lung volumes and capacities.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:783.

The most important spirometric maneuver is the FVC. To measure FVC, the patient inhales maximally, then exhales as rapidly and as completely as possible. Normal lungs generally can empty more than 80 percent of their volume in six seconds or less. The forced expiratory volume in one second (FEV1) is the volume of air exhaled in the first second of the FVC maneuver. The FEV1/FVC ratio is expressed as a percentage (e.g., FEV1 of 0.5 L divided by FVC of 2.0 L gives an FEV1/FVC ratio of 25 percent). The absolute ratio is the value used in interpretation, not the percent predicted.

TABLE 2

Normal Values of Pulmonary Function Tests

Pulmonary function test Normal value (95 percent confidence interval)

FEV1

80% to 120%

FVC

80% to 120%

Absolute FEV1 /FVC ratio

Within 5% of the predicted ratio

TLC

80% to 120%

FRC

75% to 120%

RV

75% to 120%

DLCO

> 60% to < 120%


DLCO = diffusing capacity of lung for carbon monoxide.

Adapted with permission from Salzman SH. Pulmonary function testing: tips on how to interpret the results. J Resp Dis 1999;20:812.

TABLE 2   Normal Values of Pulmonary Function Tests

View Table

TABLE 2

Normal Values of Pulmonary Function Tests

Pulmonary function test Normal value (95 percent confidence interval)

FEV1

80% to 120%

FVC

80% to 120%

Absolute FEV1 /FVC ratio

Within 5% of the predicted ratio

TLC

80% to 120%

FRC

75% to 120%

RV

75% to 120%

DLCO

> 60% to < 120%


DLCO = diffusing capacity of lung for carbon monoxide.

Adapted with permission from Salzman SH. Pulmonary function testing: tips on how to interpret the results. J Resp Dis 1999;20:812.

Some portable office spirometers replace the FVC with the FEV6 for greater patient and technician ease. The parameter is based on a six-second maneuver, which incorporates a standard time frame to decrease patient variability and the risk of complications. One of the pitfalls of using this type of spirometer is that it must be calibrated for temperature and water vapor. It should be used with caution in patients with advanced COPD because of its inability to detect very low volumes or flows. However, the FEV1/FEV6 ratio provides accurate surrogate measure for the FEV1/FVC ratio.12 The reported FEV1 and FEV6 values should be rounded to the nearest 0.1 L and the percent predicted and the FEV1/FEV6 ratio to the nearest integer.13

Spirograms and Flow Volume Curves

FIGURE 2.

Spirograms and flow volume curves. (A) Restrictive ventilatory defect. (B) Normal spirogram. (C) Obstructive ventilatory defect.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:805.

View Large

Spirograms and Flow Volume Curves


FIGURE 2.

Spirograms and flow volume curves. (A) Restrictive ventilatory defect. (B) Normal spirogram. (C) Obstructive ventilatory defect.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:805.

Spirograms and Flow Volume Curves


FIGURE 2.

Spirograms and flow volume curves. (A) Restrictive ventilatory defect. (B) Normal spirogram. (C) Obstructive ventilatory defect.

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:805.

Different spirographic and flow volume curves are shown in Figure 2.11 It is important to understand that the amount exhaled during the first second is a constant fraction of the FVC, regardless of lung size. The significance of the FEV1/FVC ratio is twofold. It quickly identifies patients with airway obstruction in whom the FVC is reduced, and it identifies the cause of a low FEV1. Normal spirometric parameters are shown in Table 2.14

Indications for Office Spirometry

Spirometry is designed to identify and quantify functional abnormalities of the respiratory system. The NLHEP recommends that primary care physicians perform spirometry in patients 45 years of age or older who are current or former smokers; in patients who have a prolonged or progressive cough or sputum production; or in patients who have a history of exposure to lung irritants.9 Other indications for spirometry are to determine the strength and function of the chest, follow disease progression,15,16 assess response to treatment,17,18 and obtain baseline measurements before prescribing drugs that are potentially toxic to the lungs, such as amiodarone (Cordarone) and bleomycin (Blenoxane).19 Spirometry also is helpful in preoperative risk assessment for many surgeries20-23 and often is used in workers' compensation and disability claims to assess occupational exposure to inhalation hazards.24  Tables 3 and 4 list indications and contraindications for spirometry.

TABLE 3

Indications for Spirometry

Detecting pulmonary disease

History of pulmonary symptoms

Chest pain or orthopnea

Cough or phlegm production

Dyspnea or wheezing

Physical findings

Chest wall abnormalities

Cyanosis

Decreased breath sounds

Finger clubbing

Abnormal laboratory findings

Blood gases

Chest radiograph

Assessing severity or progression of disease

Pulmonary diseases

Chronic obstructive pulmonary disease

Cystic fibrosis

Interstitial lung diseases

Sarcoidosis

Cardiac diseases

Congestive heart failure

Congenital heart disease

Pulmonary hypertension

Neuromuscular diseases

Amyotrophic lateral sclerosis

Guillain-Barré syndrome

Multiple sclerosis

Myasthenia gravis

Risk stratification of patients for surgery

Thoracic surgeries

Lobectomy

Pneumonectomy

Cardiac surgeries

Coronary bypass

Correction of congenital abnormalities

Valvular surgery

Organ transplantation

General surgical procedures

Cholecystectomy

Gastric bypass

Evaluating disability or impairment

Social Security or other compensation programs

Legal or insurance evaluations

TABLE 3   Indications for Spirometry

View Table

TABLE 3

Indications for Spirometry

Detecting pulmonary disease

History of pulmonary symptoms

Chest pain or orthopnea

Cough or phlegm production

Dyspnea or wheezing

Physical findings

Chest wall abnormalities

Cyanosis

Decreased breath sounds

Finger clubbing

Abnormal laboratory findings

Blood gases

Chest radiograph

Assessing severity or progression of disease

Pulmonary diseases

Chronic obstructive pulmonary disease

Cystic fibrosis

Interstitial lung diseases

Sarcoidosis

Cardiac diseases

Congestive heart failure

Congenital heart disease

Pulmonary hypertension

Neuromuscular diseases

Amyotrophic lateral sclerosis

Guillain-Barré syndrome

Multiple sclerosis

Myasthenia gravis

Risk stratification of patients for surgery

Thoracic surgeries

Lobectomy

Pneumonectomy

Cardiac surgeries

Coronary bypass

Correction of congenital abnormalities

Valvular surgery

Organ transplantation

General surgical procedures

Cholecystectomy

Gastric bypass

Evaluating disability or impairment

Social Security or other compensation programs

Legal or insurance evaluations

Interpreting Spirometry Results

Spirometry requires considerable patient effort and cooperation. Therefore, results must be assessed for validity before they can be interpreted.17,25 Inadequate patient effort can lead to misdiagnosis and inappropriate treatment. An algorithm for interpreting spirometry results is given in Figure 3.

TABLE 4

Contraindications to Use of Spirometry

Acute disorders affecting test performance (e.g., vomiting, nausea, vertigo)

Hemoptysis of unknown origin (FVC maneuver may aggravate underlying condition.)

Pneumothorax

Recent abdominal or thoracic surgery

Recent eye surgery (increases in intraocular pressure during spirometry)

Recent myocardial infarction or unstable angina

Thoracic aneurysms (risk of rupture because of increased thoracic pressure)

TABLE 4   Contraindications to Use of Spirometry

View Table

TABLE 4

Contraindications to Use of Spirometry

Acute disorders affecting test performance (e.g., vomiting, nausea, vertigo)

Hemoptysis of unknown origin (FVC maneuver may aggravate underlying condition.)

Pneumothorax

Recent abdominal or thoracic surgery

Recent eye surgery (increases in intraocular pressure during spirometry)

Recent myocardial infarction or unstable angina

Thoracic aneurysms (risk of rupture because of increased thoracic pressure)

The clinical context of the test is important because parameters in patients with mild disease can overlap with values in healthy persons.26 Normal spirometry values may vary, and interpretation of results relies on the parameters used. The normal ranges for spirometry values vary depending on the patient's height, weight, age, sex, and racial or ethnic background.27,28 Predicted values for lung volumes may be inaccurate in very tall patients or patients with missing lower extremities. FEV1 and FVC are greater in whites compared with blacks and Asians. FVC and VC values vary with the position of the patient. These variables can be 7 to 8 percent greater in patients who are sitting during the test compared with patients who are supine. FVC is about 2 percent greater in patients who are standing compared with patients who are supine.

Interpreting Spirometry Results

FIGURE 3.

Algorithm for interpreting results of spirometry. (DLCO = diffusing capacity of lung for carbon monoxide; VA = alveolar volume.)

View Large

Interpreting Spirometry Results


FIGURE 3.

Algorithm for interpreting results of spirometry. (DLCO = diffusing capacity of lung for carbon monoxide; VA = alveolar volume.)

Interpreting Spirometry Results


FIGURE 3.

Algorithm for interpreting results of spirometry. (DLCO = diffusing capacity of lung for carbon monoxide; VA = alveolar volume.)

To determine the validity of spirometric results, at least three acceptable spirograms must be obtained. In each test, patients should exhale for at least six seconds and stop when there is no volume change for one second. The test session is finished when the difference between the two largest FVC measurements and between the two largest FEV1 measurements is within 0.2 L. If both criteria are not met after three maneuvers, the test should not be interpreted. Repeat testing should continue until the criteria are met or until eight tests have been performed.26

Figure 425 shows normal flow-volume and time-volume curves. Notice that the lines of the flow-volume curve are free of glitches and irregularities. The volume-time curve extends longer than six seconds, and there are no signs of early termination or cutoff.

If the test is valid, the second step is to determine whether an obstructive or restrictive ventilatory pattern is present. When the FVC and FEV1 are decreased, the distinction between an obstructive and restrictive ventilatory pattern depends on the absolute FEV1/FVC ratio. If the absolute FEV1/FVC ratio is normal or increased, a restrictive ventilatory impairment may be present. However, to make a definitive diagnosis of restrictive lung disease, the patient should be referred to a pulmonary laboratory for static lung volumes. If the TLC is less than 80 percent, the pattern is restrictive, and diseases such as pleural effusion, pneumonia, pulmonary fibrosis, and congestive heart failure should be considered.

A reduced FEV1 and absolute FEV1/FVC ratio indicates an obstructive ventilatory pattern, and bronchodilator challenge testing is recommended to detect patients with reversible airway obstruction (e.g., asthma). A bronchodilator is given, and spirometry is repeated after several minutes. The test is positive if the FEV1 increases by at least 12 percent and the FVC increases by at least 200 mL. The patient should not use any bronchodilator for at least 48 hours before the test. A negative bronchodilator response does not completely exclude the diagnosis of asthma.

The mid-expiratory flow rate (FEF25–75%) is the average forced expiratory flow rate over the middle 50 percent of the FVC. It can help in the diagnosis of an obstructive ventilatory pattern. Because it is dependent on FVC, the FEF25–75% is highly variable. In the correct clinical situation, a reduction in FEF25–75% of less than 60 percent of that predicted and an FEV1/FVC ratio in the low to normal range may confirm airway obstruction.29

The maximal voluntary ventilation (MVV) maneuver is another test that can be used to confirm obstructive and restrictive conditions. The patient is instructed to breathe as hard and fast as possible for 12 seconds. The result is extrapolated to 60 seconds and reported in liters per minute. MVV generally is approximately equal to the FEV1 × 40. A low MVV can occur in obstructive disease but is more common in restrictive conditions. If the MVV is low but FEV1 and FVC are normal, poor patient effort, a neuromuscular disorder, or major airway lesion must be considered.

Spirometric Flow Diagram

FIGURE 4.

Normal spirometric flow diagram. (A) Flow-volume curve. (B) Volume-time curve. The smooth lines, expiratory time of greater than six seconds, and quick peak of the peak expiratory flow rate indicate a good spirometric effort.

Reprinted with permission from Crapo RO. Pulmonary-function testing. N Engl J Med 1994;331:28.

View Large

Spirometric Flow Diagram


FIGURE 4.

Normal spirometric flow diagram. (A) Flow-volume curve. (B) Volume-time curve. The smooth lines, expiratory time of greater than six seconds, and quick peak of the peak expiratory flow rate indicate a good spirometric effort.

Reprinted with permission from Crapo RO. Pulmonary-function testing. N Engl J Med 1994;331:28.

Spirometric Flow Diagram


FIGURE 4.

Normal spirometric flow diagram. (A) Flow-volume curve. (B) Volume-time curve. The smooth lines, expiratory time of greater than six seconds, and quick peak of the peak expiratory flow rate indicate a good spirometric effort.

Reprinted with permission from Crapo RO. Pulmonary-function testing. N Engl J Med 1994;331:28.

Once the ventilatory pattern is identified, the severity of the disease must be determined. The American Thoracic Society has developed a scale to rate the severity of disease based on predicted FEV1 and TLC.29

The final step in interpreting spirometry is to determine if additional testing is needed to further define the abnormality detected by spirometry. Measurement of static lung volumes, including FRC, is required to make a definitive diagnosis of restrictive lung disease.

Final Comment

Basic spirometry can be performed in the family physician's office with relative ease and inexpensive equipment. In most cases, office spirometry provides an adequate assessment of pulmonary function. In addition, spirometry may be used to address major issues in clinical management and health screening.

The Authors

TIMOTHY J. BARREIRO, D.O., is a second-year pulmonary disease and critical care medicine fellow at the University of Rochester (N.Y.) School of Medicine and Dentistry, Strong Memorial Hospital. Dr. Barreiro earned his medical degree from Ohio University College of Osteopathic Medicine, Athens, and completed an internal medicine residency at Allegheny General Hospital in Pittsburgh, Pa.

IRENE PERILLO, M.D., is assistant professor of medicine and director of the outpatient pulmonary clinic at the University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital. Dr. Perillo earned her medical degree from State University of New York Upstate Medical University, Syracuse, and completed an internal medicine residency, and pulmonary and critical care fellowship at the University of Rochester School of Medicine and Dentistry.

Address correspondence to Timothy J. Barreiro, D.O., University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Box 692, Rochester, NY 14642 (e-mail: Timothy_Barreiro@urmc.rochester.edu). Reprints are not available from the authors.

The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.

REFERENCES

1. Murray CJ, Lopez AD. Evidence-based health policy—lessons from the Global Burden of Disease Study. Science. 1996;274:740–3.

2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet. 1997;349:1498–504.

3. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349:1436–42.

4. Holleman DR Jr, Simel DL. Does the clinical examination predict airflow limitation? JAMA. 1995;273:313–9.

5. Mannino DM, Gagnon RC, Petty T L, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2000;160:1683–9.

6. Kannel WB, Hubert H, Lew EA. Vital capacity as a predictor of cardiovascular disease: the Framingham study. Am Heart J. 1983;105:311–5.

7. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline ofFEV1. The Lung Health Study. JAMA. 1994;272:1497–505.

8. Harris T, Woteki C, Briefel RR, Kleinman JC. NHANES III for older persons: nutrition content and methodological considerations. Am J Clin Nutr 1989;50(5 Suppl):1145–9, 1231–5.

9. Petty T L, Weinmann GG. Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. National Heart, Lung, and Blood Institute Workshop Summary. Bethesda, Maryland, August 29–31, 1995. JAMA. 1997;277:246–53.

10. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256–76.

11. Gold WM. Pulmonary function testing. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine, 3d ed. Philadelphia: Saunders, 2000:781–871.

12. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999; 159:179–87.

13. Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program. Chest. 2000;117:1146–61.

14. Salzman SH. Pulmonary function testing: tips on how to interpret the results. J Respir Dis. 1999;20:809–22.

15. Alhamad EH, Lynch JP 3d, Martinez FJ. Pulmonary function tests in interstitial lung disease: what role do they have?. Clin Chest Med. 2001;22:715–50,ix.

16. Flaherty KR, Martinez FJ. The role of pulmonary function testing in pulmonary fibrosis. Curr Opin Pulm Med. 2000;6:404–10.

17. Colp CR. Interpretation of pulmonary function tests. Chest. 1979;76:377–8.

18. Rosenberg DM, Weinberger SE, Fulmer JD, Flye MW, Fauci AS, Crystal RG. Functional correlates of lung involvement in Wegener's granulomatosis. Use of pulmonary function tests in staging and follow-up. Am J Med. 1980;69:387–94.

19. Kanji Z, Sunderji R, Gin K. Amiodarone-induced pulmonary toxicity. Pharmacotherapy. 1999;19:1463–6.

20. Dunn WF, Scanlon PD. Preoperative pulmonary function testing for patients with lung cancer. Mayo Clin Proc. 1993;68:371–7.

21. Celli BR. What is the value of preoperative pulmonary function testing? Med Clin North Am. 1993;77:309–25.

22. Culver BH. Preoperative assessment of the thoracic surgery patient: pulmonary function testing. Semin Thorac Cardiovasc Surg. 2001; 13:92–104.

23. Powell CA, Caplan CE. Pulmonary function tests in preoperative pulmonary evaluation. Clin Chest Med. 2001;22:703–14,viii.

24. Sood A, Redlich CA. Pulmonary function tests at work. Clin Chest Med. 2001; 22:783–93.

25. Crapo RO. Pulmonary-function testing. N Engl J Med. 1994; 331:25–30.

26. Crapo RO, Morris AH. Pulmonary function testing: sources of error in measurement and interpretation. South Med J. 1989;82:875–9.

27. Petty T L. Simple office spirometry. Clin Chest Med. 2001; 22:845–59.

28. Margolis ML, Montoya FJ, Palma WR Jr. Pulmonary function tests: comparison of 95th percentile-based and conventional criteria of normality. South Med J. 1997;90:1187–91.

29. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am J Respir Crit Care Med. 1991; 144:1202–18.



Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Download PDF
  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article